Located in the pituitary gland at the base of the brain, Rathke cleft cysts are benign (noncancerous) fluid-filled growths. While many people don’t report any symptoms, they can cause headaches and fatigue. Treatment isn’t always necessary, but can include drainage surgery or cyst removal surgery.
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What Is Rathke Cleft Cyst?
A Rathke cleft cyst is a rare type of cyst on the pituitary gland, the organ at the base of the brain that is in charge of making hormones needed for growth and function.
The Rathke cleft cyst is believed to originate from remnants of the Rathke pouch. During embryonic development, the Rathke pouch forms as a depression in the roof of the mouth, eventually losing its connection to the pharynx muscle in the throat. It gives rise to the anterior pituitary gland.
If, instead of regressing, the cleft persists and enlarges as the baby grows, it may form into a Rathke cleft cyst.
Most of these cysts are:
- Asymptomatic.
- Discovered incidentally from imaging studies for other conditions.
- Very small (less than 2 mm).
In some instances, continual accumulation of fluid may cause the cyst to grow.
As it grows, it places pressure on surrounding structures, including:
- Pituitary gland.
- Optic chiasm.
- Hypothalamus.
In some rare cases, the cyst grows large enough to produce some symptoms.
How common is Rathke cleft cyst?
Rathke cleft cyst is relatively rare — up to 5% of the U.S. population is thought to have it. Since many people don’t show any symptoms and might never know they have it, this number could be higher.
What causes Rathke cleft cyst?
Rathke’s cleft cysts develop in utero, when fluid gets into the Rathke pouch while the pituitary gland is being developed, creating a pocket of trapped, mucus-like fluid.
Rathke's cleft cyst risk factors
You may be at a higher risk of Rathke’s cleft cyst if you:
- Are between 30 and 50 years old.
- Have a family history of the condition.
- Have had pituitary gland complications in the past.
Complications of Rathke's cleft cyst
If you have Rathke’s cleft cyst, you may develop other conditions such as:
- Arginine vasopressin disorders, which affect the body’s ability to retain water and urine.
- Hyperprolactinemia, or high levels of prolactin in the blood.
- Hydrocephalus, or too much cerebrospinal fluid in your brain.
What Are the Signs and Symptoms of Rathke Cleft Cyst?
Many Rathke cleft cysts are asymptomatic, meaning they do not cause any noticeable symptoms.
As the cysts get larger, they may press on surrounding structures and cause physical symptoms such as:
- Fatigue.
- Headaches.
- Nausea.
- Vision disturbances of loss of vision.
If the cyst is pressing on the pituitary gland, it may cause hormonal symptoms such as:
- Digestive complications.
- Dry skin.
- Inability to control body temperature.
- Low blood pressure.
- Low libido.
When should I see a doctor about my Rathke cleft cyst symptoms?
If you are experiencing any of the above symptoms, talk with your health care provider about Rathke cleft cyst. They can help create a personalized care plan.
How Do You Diagnose Rathke's Cleft Cyst?
To diagnose a Rathke cleft cyst, your doctor will ask about your symptoms and family history and perform a physical exam. They will also order tests to determine a formal diagnosis.
Tests to diagnose Rathke cleft cyst
- Blood tests — To determine if your pituitary gland is functioning properly.
- MRI and CT scans — To detect the presence of a mass and show its cystic character. This usually happens incidentally when searching for another condition.
- Vision tests — To help determine if the cyst is putting pressure on the optic nerve.
A correct diagnosis is particularly important for Rathke cleft cysts because the treatment differs from that of other possible lesions.
The diagnosis is confirmed by a sample of the cystic capsule sent for pathological analysis during surgical drainage of the cyst.
How Do You Treat Rathke Cleft Cyst?
For most people, their Rathke cleft cyst doesn’t produce any symptoms, so there is no need to remove it. Long-term observation by a doctor is usually sufficient.
Still, for others, their symptoms may be interfering with their quality of life and may require surgical drainage and/or cyst removal.
Surgery to treat Rathke cleft cyst
An endoscopic endonasal approach (EEA) surgery may be used for patients who need their Rathke cleft cyst removed. In this state-of-the-art, minimally invasive approach, surgeons access the cyst through the natural corridor of the nose, without making an open incision. Surgeons then remove the cyst through the nose and nasal cavities.
EEA offers the benefits of no incisions to heal, no disfigurement, and a faster recovery time.
Complications from surgery include infection and bleeding, but the outcomes are generally successful.
After surgery, you can expect follow-up MRI imaging to monitor for recurrence or the cyst's return.
